[Experience with a local health system in Santa Cruz, Bolivia]

In 1988 the health care network in Bolivia had 80 health districts, of which 18 were urban and 62 were rural. The city of Santa Cruz de la Sierra, located in the country's tropical area, was divided into five health districts. One of these was selected for implementation of a local health system, based on four priority criteria: socioeconomic situation, epidemiologic profile, access to health services, and services coverage. After the model had been in place for ten months, significant results could be seen, which are summarized as follows: effective participation by the people in the district, increased demand for preventive services, interest in receiving information and health education, satisfaction on the part of the people with the actions carried out vis-à-vis the perceived needs, and effective coordination of all the institutions making up the local health system.